Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School.
Plast Reconstr Surg. 2009 Dec;124(6):2027-2039. doi: 10.1097/PRS.0b013e3181bcefe0.
Devastating brachial plexus injury with multiple root avulsions results in wrist instability, imbalance, and inability of patients to control the placement of their hand in space. In this study, results of wrist arthrodesis were analyzed in relation to factors such as age, severity score, and additional hand reanimation procedures. Indices of patient satisfaction were also measured using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires.
Between January of 1978 and January of 2006, 97 patients with posttraumatic plexopathies underwent secondary procedures for hand reanimation. Sixty-one of these patients had wrist fusion. Arthrodesis was performed between the radius and third metacarpal using mainly a rigid plate; iliac bone graft was used in the majority of patients. Thirty-one patients underwent muscle transfers (45 free muscles) and 11 had tendon transfers in the wrist fusion group to enhance finger function. Patient self-assessment was carried out using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires.
All patients' wrists fused. Patients with free-muscle transfer for finger flexion and extension achieved superior muscle grading compared with patients without wrist fusion, but this was not significant. A total of 35 patients (57.37 percent) answered the questionnaires; 97.14 percent were satisfied with wrist stability and 88.57 percent reported that the procedure enhanced the overall upper limb function. The Disabilities of the Arm, Shoulder and Hand score was 59.14 +/- 12.9, which means moderate ability in daily activities.
Wrist fusion in patients with brachial plexus palsy is recommended as a complementary procedure, offering a stable, painless carpus, with improvement of overall upper limb function and appearance.
毁灭性的臂丛神经损伤伴多发神经根撕脱会导致腕关节不稳定、失衡，以及患者无法控制手部在空间中的位置。本研究分析了腕关节融合术的结果与年龄、严重程度评分以及手部再神经支配附加手术等因素的关系。采用 Terzis 和 Disabilities of the Arm, Shoulder and Hand 问卷评估患者满意度指数。
1978 年 1 月至 2006 年 1 月期间，97 例创伤性臂丛神经病患者接受了手部再神经支配的二次手术。其中 61 例患者行腕关节融合术。采用主要为刚性板的桡骨和第三掌骨融合，大多数患者采用髂骨移植。在腕关节融合组，31 例患者行肌肉转移（45 例游离肌肉），11 例患者行肌腱转移以增强手指功能。采用 Terzis 和 Disabilities of the Arm, Shoulder and Hand 问卷对患者进行自我评估。
所有患者的腕关节均融合。行游离肌肉移植以实现手指屈伸的患者肌肉功能分级优于未行腕关节融合的患者，但差异无统计学意义。共有 35 例（57.37%）患者回答了问卷；97.14%的患者对腕关节稳定性满意，88.57%的患者报告称该手术提高了整体上肢功能。手臂、肩和手残疾评分（Disabilities of the Arm, Shoulder and Hand score）为 59.14±12.9，这意味着日常活动能力中等。
建议臂丛神经损伤患者行腕关节融合术作为一种补充性手术，提供稳定、无痛的腕关节，改善整体上肢功能和外观。
